Nipple Confusion – What Is It And How Do I Fix It?

Nipple confusion is what happens when a mother uses artificial nipples (e.g. a bottle teat or dummy/pacifier), and a breastfed baby then becomes accustomed to a different way of attaching, or a different milk flow.

This can result in breastfeeding problems, such as poor attachment to the breast, fussiness at the breast or breast refusal.

It’s important to note that while artificial nipple use can result in nipple confusion, there’s no absolute certainty that it will.

Some babies go back and forth from breast to artificial nipple with no issues.

So, how might nipple confusion lead to various breastfeeding problems and what can be done to fix it?

Breastfeeding Problems That May Result From Nipple Confusion

Attachment Problems

How a baby attaches to an artificial teat is different from how she attaches to the breast.

When attaching to the breast, a baby must open her mouth wide and take the nipple far back into her mouth. When a baby attaches to an artificial nipple, it typically goes only a short distance inside her mouth, so she doesn’t have to open her mouth so wide.

Because of that, artificial nipple use can result in a baby ‘unlearning’ how to attach to the breast in the most effective way, and therefore having a shallower attachment to the breast. A shallow attachment can lead to sore nipples.

Shallower attachment can also mean less milk is removed. Over time, unless the attachment is not corrected, the mother’s milk supply will be reduced.

Breast Refusal

When drinking milk from the breast, a baby takes an active role. Her tongue is pushed forward and down (under the nipple and breast), cupping the breast and extending over her bottom gum. She has to be more active, moving her tongue to its lowest position to create a vacuum to remove the milk.

When drinking from a bottle, the firm bottle teat in a baby’s mouth provides a strong stimulus for her to suck. When she sucks, she gets a continuous and generally faster flow of milk than when she breastfeeds.

A baby who receives this continuous, fast flow of milk from a bottle, with less active participation, might develop a preference for it, instead of the active participation needed to remove a less continuous and often slower flow from the breast. If this happens, the baby might become either very fussy with breastfeeding, or refuse to breastfeed at all (which can lead to weaning).

While dummies obviously don’t provide milk, research shows that shows dummy use also reduces the duration of breastfeeding. See here for more information.

How To Avoid Nipple Confusion

Breastfeeding is instinctive for babies. Most healthy term babies can breastfeed well immediately after being born. Avoiding the use of artificial nipples whenever possible until breastfeeding is well established (e.g. for the first 6 weeks) can help babies optimise what they can instinctively do at birth.

Getting breastfeeding off to the best start possible minimises the need for any form of supplementation (and the potential use of bottles). Understanding normal newborn behaviour and the various settling strategies helps avoid the use of a dummy. Settling or comforting your baby with the breast is a great strategy too. Some women are told not to use the breast as a dummy or pacifier, but comfort feeding is beneficial to both mothers and babies.

If bottle use is unavoidable, try using a paced bottle feeding method (also known as bottle nursing) and a slow flow teat; this will minimise the risk of nipple confusion.

How To Fix Nipple Confusion

If you feel nipple confusion is causing a problem for you or your baby, there is a lot that can be done about it. Seek help from a breastfeeding support organisation (such as the Australian Breastfeeding Association, or LLLI in the US), or a lactation consultant.

BellyBelly also has several articles that will help you navigate nipple confusion:

Nipple confusion doesn’t mean dummies and bottles are always a no-no. If you use a dummy or bottles for your breastfed baby and find it works for you without causing any problems, great! If you’re worried about nipple confusion, be sure to ask for help. If you’re expecting a baby or you’re wondering if you should or shouldn’t introduce a dummy or bottle to your breastfed baby, it might be better to wait until breastfeeding is established (about 6 weeks) before doing so.

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Renee Kam IBCLCCONTRIBUTOR

Renee Kam is a mother of two daughters, an International Board Certified Lactation Consultant (IBCLC), a physiotherapist, author of 'The Newborn Baby Manual' and an Australian Breastfeeding Association Counsellor. In her spare time, Renee enjoys spending time with family and friends, horse riding, running and reading.

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